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12-22-14
CJEF�3�IFIC�Tj��i O�' i�i��'�C� d1�iUEI� �a. �.C. �u�� 5.b(a) �FGISTr-_R or "'ILLS vrnbcr _cov-�T�Y,�L��sYLv��I_� Name of Decedent��,('� L �p,�OG Date of Death: aQ _'�,� — OO�� File Num'eer: ctv� Date Letters Granted:�p� f� � To the Register: I certify that Notice of Estate Administration requii•ed by Pa. O.C.Rule 5.6(a)of the Orphails' Court Rules was served on or mailed to the follo�ving beneficiaries of the avove-captioned estate on /1� -�,��� : Name: Address: ob; G� -Jon�.� ��r----�.� ; f�4 I 701 Z _ � .5or�2� �I tY��-�.Qp �) (' rli Sl P PA 17�IS �v�u nnr� J o�QS ► � EJ���r �0�5 � � �(�a.'t"�r.n �o�ni2�_— � � ----- _���e �,.��r;�-�e- a��� l�� N�.�c, ro a�11 � (Ijr�iore space is r..eeded, al(aclz seperrate slzeet.) ` �— Notice has now been given to ali persons entitled thereto underYa. O.C.Rule 5.6(a)except: � �Dnl�,//(�fr'[_���T���e//{'L —�-�F- f—•�� UJ _,�� �.. � maan•e ojPersm� �iny diis o G� -- --7 �i � �y,M � l.� �,-� C_:a � �,_ �_ c� �,, �.,� Capacity: �nersonal Representative C�Couiisel C:;, c�.`�> ,,� _.„. C:� t':�.- N t:G � .r;� � ,��T O l����S � ��,,� � �.. Nnn�e ojPerson!'iling rhis Faiu --- _ N � -c� "d Q � � � � ° �7 .�J��l�r• � LZ,J � C`j � Adrlress — � `� � � �l%_��i��� - �..� -- �,��- sTs_-3��_ . � r��,�,,i,��,� --